Do We Want to Make It Home for the Holidays?

If you spend enough time in EMS, you learn to accept a certain level of risk. You learn to run toward things most people run away from. You learn to operate in the worst moments of someone else’s life and still keep your head clear enough to act. That’s the job. That’s the calling.

But there’s a question I’ve been asking myself more and more as another holiday season approaches—one that I think all of us, from field providers to chiefs, need to confront honestly:

Do we want to make it home for the holidays?

It’s not a motivational slogan. It’s not a rhetorical flourish. It’s a reality check about the way we drive, the decisions we make behind the wheel, the culture we’ve normalized, and the very real risks that come with it. For many EMS crews, the deadliest part of the job isn’t the violence, the exposures, or even the complex medical calls: It’s the drive.

The Hidden Danger in the Driver’s Seat

In 2023, 32 people were killed in crashes involving ambulances, according to the National Safety Council’s analysis of federal crash data. That number alone should make every EMS leader sit up straighter. But what worries me even more is this:

Thirteen of those deaths were EMS workers—drivers or crewmembers. That’s more than 40% of all fatalities tied to ambulance collisions.

For comparison:

• Police vehicles were involved in 134 fatalities, but only 17 of those were officers.
• Fire apparatus were involved in 32 fatalities, but only 5 were firefighters.

In other words, EMS providers are more likely to die inside their own rigs than police officers or firefighters are in theirs.

That’s a devastating statistic, and it cuts against the heroic but misguided belief that the ambulance is some kind of protective bubble. It’s not. It’s a 10,000-pound box with questionable aerodynamics, a high center of gravity, a poorly secured patient compartment, and—too often—a heavy foot on the accelerator.

And the circumstances behind these fatal crashes aren’t usually dramatic rollovers or catastrophic mechanical failures. Most are routine roadway collisions—intersections, side impacts, passing errors, wet roads, or responding on familiar city streets we’ve driven a thousand times.

We don’t need a Hollywood-style disaster to get someone killed. All it takes is a moment of complacency or the wrong decision at the wrong time.

Lights, Sirens, and the Illusion of Urgency

There’s a long-standing belief in EMS that lights and sirens equal faster care. Shaving a minute or two off the clock can equal saving a life. That’s the justification we give ourselves—and the public—when we hit the switch panel.

But the evidence doesn’t support the myth.

A 2019 study in Annals of Emergency Medicine—one of the strongest analyses we have—found:

• Responding with lights and sirens increases crash risk by 20%.
• Transporting with lights and sirens more than doubles the crash rate—from 7.0 to 16.5 crashes per 100,000 transports.

Put plainly, we are twice as likely to crash with a patient on board when we run hot.

And for what? The median time saved on scene response is often in the 42- to 60-second range in urban and suburban systems. In rural areas, the benefit is even more variable, often wiped out by roadway limitations, geography, or weather.

As a former full-time field paramedic, now working in another role, I’ve watched cultures rise and fall around lights and sirens. Some agencies run hot to almost everything. Some are improving, using high-acuity protocols and tiered responses that drastically reduce L&S utilization. Others remain stuck in old habits.

It’s not about blaming medics or drivers. It’s about removing the blinders imposed by tradition.

• Lights and sirens don’t make us safer.
• Lights and sirens don’t make other drivers predictable.
• Lights and sirens don’t suspend physics.

And they certainly don’t guarantee we’ll make it home.

The Speed We Don’t Talk About

There’s a truth in EMS that rarely makes it into policies, lectures, or safety briefings. We drive too fast even when we’re not running lights and sirens. Every provider reading this knows it.

• Sometimes it’s adrenaline after a tough call.
• Sometimes it’s fatigue pushing us to get back to the station before the next tone drops.
• Sometimes it’s culture—“We always run a little hot on the highway stretch.”
• Sometimes it’s convenience.

But speed is speed, whether the lightbar is lit or not. And speed mixed with a heavy, top-heavy emergency vehicle on variable terrain is a deadly combination.

If you’ve ever driven through the mountains of Northeast Tennessee on wet pavement at night, or you’ve ever had an inattentive driver pull in front of you at a blind intersection, you know how little margin for error we have.

The more we normalize unnecessary speed, the more we accept a deadly lie: “It’s not that dangerous because nothing bad has happened—yet.”

“Yet” is a dangerous word in public safety. It’s where complacency grows, and where tragedies start.

The Culture Problem

Most EMS workers are not risk-seekers. They’re not careless. They’re not trying to put themselves or their partners in danger. What we have is a culture problem, not a character problem.

We often teach speed—explicitly or implicitly:

• “Make good time to the hospital.”
• “Let’s get back in service.”
• “Don’t lose time on the highway.”
• “You can shave a few minutes if you take the bypass.”

We incentivize speed:

• Quick chute times are celebrated.
• Fast response intervals are seen as a badge of pride.
• Dispatch systems generate pressure.

Agencies compare themselves to stopwatch metrics. We rarely celebrate the medic who chooses caution, the EMT who slows down in a construction zone, the driver who waits for cross-traffic to stop completely, or the crew who elects no lights and sirens on a stable patient. The safest medic isn’t the fastest medic. The safest medic is the one who gets the crew, the patient, and the rig home.

What Must Change—Top Down, Bottom Up

The good news is that changing this culture doesn’t require new technology, new regulations, or millions of dollars in equipment. It requires leadership and honesty.

1. Reevaluate your lights-and-sirens policies. Not every call needs them, and most transports don’t. In many conditions—dense traffic, high-speed roadways, icy roads, heavy rain—lights and sirens increase delays by making other drivers panic or become unpredictable.
2. Evidence-based dispatch and transport protocols are essential. You can’t defend a practice based on, “We’ve always done it this way.”
3. Train for habits, not heroics. Driver training must go beyond initial EVOC certifications. EMS agencies should prioritize:
   • Defensive driving refreshers
   • Intersection management
   • Speed discipline
   • High-risk/low-frequency scenarios with simulations
   • Wet-weather and low-visibility training
   • Backing safety drills
   • Fatigue management strategies (Are your people still working 24-hour shifts?)

Driving is a clinical skill. It deserves the same ongoing education as airway management or pharmacology.

Monitor Speed and Hold Ourselves Accountable

This doesn’t require punitive action. It requires transparency. Speed monitoring systems, GPS feedback, and periodic reviews can help crews identify patterns early. Accountability doesn’t have to be adversarial. It can be collaborative—“We’re watching this because we care if you survive.”

Put Safety in the Conversation—Every Shift

Morning briefing. Shift change. Training day. Quality improvement meetings. If we talk about safety only after a crash, we’re already too late.

Empower Drivers and Crews to Say No

If a driver is uncomfortable with the weather, fatigue, roadway conditions, or speed, they should have the authority to slow down or stop. A driver who says “I’m not comfortable driving that fast” is protecting the entire crew.

Leaders Must Model the Behavior

Nothing kills a safety culture faster than leadership hypocrisy.

• If a supervisor flies up the interstate at 85 mph, every crew notices.
• If a chief screams for faster response times, every provider hears it.
• If a training officer teaches caution but drives recklessly, the lesson is lost.

Leadership sets the tone—always.

A Holiday Reminder

The holiday season amplifies every challenge EMS faces:

• Busier roads
• Impaired drivers
• Holiday stress
• Fatigue from long shifts
• More calls
• Weather hazards
• Emotional exhaustion

It’s also the time of year when we feel the absence of fallen providers the most. Empty chairs hit harder in December.

As we enter another holiday season, I want every EMT, paramedic, supervisor, and chief reading this to ask themselves three questions before hitting the switch for lights and sirens, or before pushing that accelerator a little harder:

1. Is this call worth risking my life?
2. Is this transport truly time-critical?
3. Can I slow down and still do my job well?

The answer to that third question, in most cases, is yes—you absolutely can slow down.

Our families aren’t asking us to be slower EMTs or slower paramedics. They’re asking us to come home. Our partners want to finish the shift alive, patients need us to arrive safely, and our communities need us to model responsibility.

The holiday season isn’t just about joy and gatherings. For too many EMS families, it’s also a season of remembrance. We owe it to ourselves and those waiting at home to stop pretending speed is synonymous with professionalism. It’s not. Professionalism is about accuracy, judgment, and survival.

The Reality We Must Face

Every EMS provider knows the sound of a fatal crash being toned out and has treated victims of roadway violence. We’ve heard the stories from other counties, states, and other agencies: “Crew killed in intersection collision.” “Unit struck while returning from call.” “Ambulance overturned on rural highway.”

But here’s the truth, we don’t always say out loud—The next fatality could be any one of us. It could be the brand-new EMT, a seasoned medic, supervisor, or the person who always “drives a little faster”—or the one who “never thought it would happen.” Risk is part of EMS. Unnecessary risk is not.

If you’re an EMS director, chief, or administrator reading this, you have enormous power to shift culture.

You control:

• Policy
• Training
• Budget priorities
• Vehicle replacement schedules
• Response protocols
• Organizational expectations
• Dispatch criteria
• Safety messaging

If your agency has ever celebrated “fast response crews” more than “safe response crews,” it’s time to rethink your priorities.

If you haven’t reviewed your lights-and-sirens use rates in the past year, don’t know your agency’s crash rate, speed-violation patterns, or high-risk zones, or your crews believe speed is expected—or rewarded—it’s time. Maybe your agency has had a close call recently; consider that a grace-period warning, not an anomaly.

No EMS administrator wants to call a spouse during the holidays to say their loved one isn’t coming home. And no EMS partner should have to bury a coworker because of a preventable crash.

Making It Home

At the end of the day, EMS is a profession built on service. We run into danger because others can’t, responding when the world calls. In EMS, we drive into storms, heartbreak, and chaos because that’s the mission. None of that mission requires reckless speed.

The holidays are a time to reconnect with what matters most. They’re also a time for EMS to reflect deeply on the risks we accept—and the ones we shouldn’t.

I want every provider reading this to make a commitment this year: “I will do everything in my power to make it home for the holidays.”

And I want every EMS leader to commit to building a culture where that promise is possible—not just in December, but year-round. Because EMS is more than a job. EMS is a family, and families deserve to come home safe.

References

1. National Safety Council (2024). Emergency Vehicles – Injury Facts. Analysis of NHTSA Fatality Analysis Reporting System (FARS) data.
2. National Highway Traffic Safety Administration (2025). FARS 2023 – Accidents Dataset. U.S. Department of Transportation.
3. Watanabe, B.L., Patterson, G.S., Kempema, J.M., Magallanes, O., & Brown, L.H. (2019). Is use of warning lights and sirens associated with increased risk of ambulance crashes? Annals of Emergency Medicine, 74(1), 101–109.